Risk Factors For Delayed Discharge After Day-surgery Percutaneous Nephrolithotomy

BackgroundPercutaneous nephrolithotomy(PCNL)is the treatment of choice with high stone-free rate and exact effect in the removal of renal stones.With the development of enhanced recovery after surgery(ERAS),shorter length of hospital stay(LOS)and fewer surgical trauma have been required by most surgeons.Day surgery is prevalent among surgeons due to its rapidly postoperative rehabilitation and high patient satisfaction.At present,day-surgery PCNL has been widely developed and its protocol is becoming more and more mature.However,some patients cannot be discharged as scheduled due to their slow recovery,which will increase the healthcare cost.Identifying the risk factors of delayed discharge in these patient subgroups,may help us to better manage day surgery.ObjectivesTo investigate the risk factors for delayed discharge after day-surgery PCNL so as to provide a theoretical basis for shortening LOS and patients selection.Methods and PatientsThe data of 205 patients who accepted day-surgery PCNL in our institution between January 2018 and February 2020 were analyzed,retrospectively.Thirty patients developed delayed discharge.Univariate and multivariate analysis were used to analyze the relevant factors.ResultsThe rate of delayed discharge was 14.6%.Univariate analysis revealed that female(p=0.030),positive urine leukocyte(p=0.005),positive urine nitrite(p=0.007),stone burden≥500mm~2(p<0.001),staghorn calculi(p=0.068),operative time≥90min(p<0.001),multiple channels(p<0.001),nephrostomy tubes(p<0.001),and residual calculi(p=0.036)were the main factors of delayed discharge after day-surgery PCNL.Furthermore,female(p=0.037),nephrostomy tubes(p=0.006),and residual calculi(p=0.036)were considered to be the independent risk factors of delayed discharge in the multivariate analysis.The main reasons that caused delayed discharge included psychosocial factors,pain,infection-related complications,and bleeding.For the female,psychosocial factors and infection-related complications accounted for the highest proportion.ConclusionsThe key to the success of day-surgery PCNL is whether the patients can be discharged within 24 hours after surgery.Our study found that female,nephrostomy tubes,and residual calculi were the independent risk factors for delayed discharge after day-surgery PCNL.For the female patients,we should pay more attention to their psychological status.Tubeless process or the placement of fewer nephrostomy tubes should be achieved as far as possible.Furthermore,removing the stone completely at one time is beneficial to patients’ rehabilitation.